Gout

February 3, 2017

Gout is one of the most painful forms of arthritis and is the source of disability for many. It is caused by an accumulation of uric acid crystals in the joints. The crystals form when there are abnormally high levels of uric acid (hyperuricemia) in the body. The classic symptoms include abrupt, burning pain, with swelling, redness, warmth, and stiffness in the joint. Gout most commonly affects the joints of the big toe, but can occur elsewhere in the body, including the joints and surrounding areas of the foot, ankle, or knee.

Today, gout is among the fastest growing diseases in the United States. More than 8.3 million people in the United States are living with gout. It is one of the oldest known diseases, known as far back as 4,000 years ago. Myths about its causes and treatment are common. One of the most popular myths is that gout is “the disease of kings” and other rich people and is caused by overindulgence. And while historically gout has been a male disease (three-fourths of cases occur in men), the incidence has been rising in older women, with as many as one in 20 over age 70 now afflicted.

What is Uric Acid?

Everyone has uric acid in their body. It is naturally present in small amounts. It is a waste product that results from the body’s normal processes. Cells die and release chemicals called purines. Uric acid is made from purines. When we eat or drink high-purine foods, uric acid levels go up. High uric acid levels are part of what triggers a gout attack.

Normally, uric acid is dissolved in the blood and passes through the kidneys and out into the urine. But when more uric acid is produced than the kidneys can get rid of, high uric acid levels – hyperuricemia develop. High uric acid may turn into crystals in the joints. When uric acid crystals accumulate in the joints they can make for a painful attack of gout.

A gout attack is extremely painful. Some people report it feels like the affected joint is caught in a mechanical device.

 

Causes

Gout is caused initially by an excess of uric acid in the blood (hyperuricemia). Uric acid is produced in the body through the breakdown of purines – specific chemical compounds that are found in high amounts in certain foods such as meat, poultry and seafood.

 

Normally, uric acid is dissolved in the blood and is excreted from the body in urine via the kidneys. If too much uric acid is produced or not enough is excreted then it can build up and form the needle-like crystals that trigger inflammation and pain in the joints and surrounding tissue.

There are a number of factors that can increase the likelihood of hyperuricemia, and therefore gout –

  • Age and gender– Men produce more uric acid than women, though women’s levels of uric acid approach those of men after the menopause
  • Genetics – a family history of gout increases the likelihood of the condition developing
  • Lifestyle choices – Alcohol consumption interferes with the removal of uric acid from the body. Eating a high-purine diet also increases the amount of uric acid in the body
  • Lead exposure – Chronic lead exposure has been linked to some cases of gout
  • Medications – certain medications can increase the levels of uric acid in the body; these include some diuretics and drugs containing salicylate
  • Weight -Being overweight increases the risk of gout as there is more turnover of body tissue, which means more production of uric acid as a metabolic waste product. Higher levels of body fat also increase levels of systemic inflammation as fat cells produce pro-inflammatory cytokines.

Other health problems –renal insufficiency and other kidney problems can reduce the body’s ability to efficiently remove waste products, leading to elevated uric acid levels. Other conditions associated with gout include high blood pressure (hypertension), diabetes and hypothyroidism.

 

Symptoms

For many people, the first symptom of gout is excruciating pain and swelling in the big toe – often following a trauma, such as an illness or injury. Gout may also appear in another low-body joint such as the ankle or knee. Subsequent attacks may occur off and on in other joints, primarily those of the foot and knee, before becoming chronic.

Gout usually affects one joint at a time, but if left untreated it can affect many joints. Joint pain that used to resolve in a week to 10 days could become a milder, but constant pain. Eventually, untreated gout can cause other problems.

Tophi – painless but disfiguring lumps of crystals formed from uric acid may develop under the skin around joints. The crystals can also form kidney stones.

Gout is associated with other serious health risks such as high blood pressure, diabetes, chronic kidney disease and cardiovascular disease.

Four Stages of Gout –

  • Asymptomatic Hyperuricemia – At this stage, symptomatic treatment is not required, though urate crystals are being deposited in tissue and causing slight damage.
  • Acute Gout – This stage occurs when the urate crystals that have been deposited suddenly cause acute inflammation and intense pain.
  • Interval or Inter Critical Gout – Subsequent flares may not occur for months or years, though if not treated over time they can last longer and occur more frequently.
  • Chronic Tophaceous Gout – This final stage is the most debilitating form of the disease, where permanent damage may have occurred in the joints and the kidneys.

Treatment

Conventional Treatment

Medications

  • Colchicine – May be most effective when taken within the fi rst 12 hours of an acute attack. Patients may have side effects such as nausea, vomiting, abdominal cramps or diarrhea.
  • Glucocorticosteroids (cortisone) – This quickly suppresses the inflammation of an acute attack.
  • Nonsteroidal anti-infl ammatory drugs (NSAIDS)
  • Allopurinol – It decreases the body’s production of uric acid and is recommended for patients with a history of kidney stones or tophi.
  • Febuxostat – This medication is taken orally and decreases the body’s production of uric acid.
  • Pegloticase – This is an intravenous infusion of an enzyme used to dissolve gout crystals in advanced and diffi cult to control gout.
  • Probenecid – This medication increases the kidneys’ ability to remove uric acid from the body.

 

 

 

 

Alternative Treatment

Nutritional Supplements

  • A daily multivitamin, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals, such as magnesium, calcium, zinc and selenium.
  • Omega-3 fatty acids, such as fish oil helps to decrease inflammation and promote general health. Cold-water fish, such as salmon or halibut, are good sources.
  • IP-6 (inositol hexophosphonate)
  • N-acetyl cysteine for antioxidant effects.
  • Vitamin C acts as an antioxidant. Studies suggest that higher vitamin C intake helps to lower the risk of gout.
  • Acidophilus (Lactobacillus acidophilus) helps to maintain gastrointestinal tract and immune health.
  • Methylsulfonylmethane (MSM) helps to decrease inflammation.

Herbs

  • Cranberry (Vaccinium macrocarpon), for kidney health.
  • Green tea (Camelia sinensis), for antioxidant and immune effects.
  • Devil’s claw (Harpagophytum procumbens), for pain and inflammation. Devil’s claw may increase the blood-thinning effect
  • Cat’s claw (Uncaria tomentosa) for inflammation, immune, and antibacterial/antifungal activity.
  • Bromelain (Ananus comosus), for pain and inflammation.
  • Turmeric (Curcuma longa), for inflammation.

Accupuncture – May help manage pain associated with gout.

 

Reference

http://www.nhs.uk/Conditions/Gout/Pages/Symptoms.aspx

http://www.medicalnewstoday.com/articles/144827.php

http://www.nytimes.com/2011/05/10/health/10brody.html?_r=0

http://gouteducation.org/wp-content/uploads/2010/05/Gout_Brochure.pdf

http://gouteducation.org/wp-content/uploads/2010/05/Gout_Brochure.pdf

http://www.emedicinehealth.com/gout/page2_em.htm#gout_causes

http://www.pamf.org/handouts/gout.pdf

http://www.pamf.org/handouts/gout.pdf

http://www.pamf.org/handouts/gout.pdf

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